Implementation of chronic illness care in German primary care practices-how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling
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Implementation of chronic illness care in German primary care practices-how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling. / Petersen, Juliana J; Paulitsch, Michael A; Mergenthal, Karola; Gensichen, Jochen; Hansen, Heike; Weyerer, Siegfried; Riedel-Heller, Steffi G; Fuchs, Angela; Maier, Wolfgang; Bickel, Horst; König, Hans-Helmut; Wiese, Birgitt; van den Bussche, Hendrik; Scherer, Martin; Dahlhaus, Anne; MultiCare Study Group.
In: BMC HEALTH SERV RES, Vol. 14, 01.01.2014, p. 336.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Implementation of chronic illness care in German primary care practices-how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling
AU - Petersen, Juliana J
AU - Paulitsch, Michael A
AU - Mergenthal, Karola
AU - Gensichen, Jochen
AU - Hansen, Heike
AU - Weyerer, Siegfried
AU - Riedel-Heller, Steffi G
AU - Fuchs, Angela
AU - Maier, Wolfgang
AU - Bickel, Horst
AU - König, Hans-Helmut
AU - Wiese, Birgitt
AU - van den Bussche, Hendrik
AU - Scherer, Martin
AU - Dahlhaus, Anne
AU - MultiCare Study Group
PY - 2014/1/1
Y1 - 2014/1/1
N2 - BACKGROUND: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.METHODS: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).RESULTS: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.CONCLUSIONS: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient's assessment is associated not only with practice-level factors, but also with individual, patient-level factors.TRIAL REGISTRATION: Current Controlled Trials ISRCTN89818205.
AB - BACKGROUND: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.METHODS: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).RESULTS: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.CONCLUSIONS: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient's assessment is associated not only with practice-level factors, but also with individual, patient-level factors.TRIAL REGISTRATION: Current Controlled Trials ISRCTN89818205.
KW - Chronic Disease
KW - Comorbidity
KW - Cross-Sectional Studies
KW - Evidence-Based Medicine
KW - Female
KW - Germany
KW - Health Services Accessibility
KW - Humans
KW - Male
KW - Middle Aged
KW - Models, Organizational
KW - Pain Measurement
KW - Primary Health Care
KW - Prospective Studies
KW - Quality of Health Care
KW - Quality of Life
KW - Questionnaires
KW - Self Efficacy
KW - Social Support
U2 - 10.1186/1472-6963-14-336
DO - 10.1186/1472-6963-14-336
M3 - SCORING: Journal article
C2 - 25098231
VL - 14
SP - 336
JO - BMC HEALTH SERV RES
JF - BMC HEALTH SERV RES
SN - 1472-6963
ER -